Incontinence management

[MrsWobble3]

I’m hoping someone here can answer this question. My mother is bedbound - currently in hospital but they are looking to discharge her home. She has a catheter at present but it seems to be the cause of recurrent UTI infections - are pads an alternative way of managing incontinence? If not, what are the arrangements for managing the catheter at home - is it something the carers deal with? My dad thinks they will get a district nurse coming 4x a day to deal with it but that doesn’t sound likely to me. What questions should I be asking the discharge team to make sure she is safe when she comes home. My dad just wants her back so will say he can manage everything when he can’t. And he still thinks that she just needs a bit of physio when she has been bed bound since April and lost a lot of weight and muscle tone as a result. Many thanks - I’m navigating this for the first time and it’s really difficult when you don’t know what to expect or even what questions to ask.

As a district nurse we would never advocate catheters for continence management due to the risk of infection. Pads would be the way to go which in my area are funded by the NHS.

If she does come home with a catheter then it would be District nursing that changes it however weekly bag changes would be down to carers/family. Long term catheters are changed 12 weekly normally.

I can only speak as to what happens within my trust however I should imagine it's the same everywhere.

Just to add physiotherapy can be used for bed bound patients to prevent muscle wastage / aid rehabilitation. Definitely worth asking for a referral.

I worked as a home carer and often had clients with catheters that we would empty bags for, but inserting/removing them was always down to the district nursing teams. It was often quite stressful over weekends/nights if they blocked/came out........ and that was pre-Covid.

You say your Mum has been bed bound since April - it's fairly likely she will remain so. Once muscle tone is lost, it rarely comes back. Once someone becomes bed bound...... it tends to stay that way. It may be an important consideration if she's being discharged to home. You'll need a downstairs room for her where a bed can be set up easily and moved around for carers to access. Bathing can be done using bowls, flannels and towels so you don't need to worry about access to a bathroom.

Sorry to hear about this. I can completely understand your dad wanting his wife home, and saying anything to do this. Do they currently have any support/carers/cleaner etc? I'd speak to the discharge planning team and set them straight about exactly what support they do/don't have at home. A temporary rehab placement might be better till proper support is available at home.

Just some info for you. My experience was a few years ago, so things may well have changed in the community, or by area. I agree that incontinence is rarely managed by catheters at home. There are 2 main types of catheter though for this situation. 1 inserted into the urethra and for short term use. The other called an SPC (supra pubic catheter), is inserted via a minor op and goes from the skin outside, then directly into the bladder via a thin channel. You therefore have a tube come out from the pelvic area, (often just above the pubic hair line). The SPC is a longer term option, but still needs regular changing- usually by the community/district nurse specialist. There is a risk of infection with both options though.

How is your dads dexterity? The actual clip/button to empty the catheter needs a certain degree of dexterity of the fingers, so patients/cares with arthritis might find it difficult.

You need to find out IF she will be discharged with a catheter firstly, and what support has been put in place. Also, whether hoists or other devices, hospital bed etc might be needed at home.

No practical help but feeling awful for you all OP 💐 One never dreams this day will come.

Carers will empty the catheter bags and change them over, on their visits (you said 4xdaily); re-position mum (for her comfort); and clean her. Dad will likely be feeding her and getting drinks and doing tablets, unless it is in care plan for carers to do that.

Community nurses come out to do the 8-12 week change of catheter: to deal with any blockages or Uti problems- that can be fraught. Watch out for dark, cloudy or odorous urine in the bag. Or if she reports soreness or discomfort; Or not passing urine (retention- that's serious you need community nurse out urgently if that happens) and let community nurses know any changes. They are responsible for overall management of catheter care in community.

The community nursing team will review continence options, talk with mum, dad and you if you are present/ have consent, about the options.

Please make sure you register dad as carer to mum at their Gp surgery.

Thank you all so much - this is so helpful and much more informative than I have been able to get from the discharge team so far. I feel much better equipped for my next conversation - thank you.

My dad had recurrent UTIs through use of catheters and it’s caused him a huge amount of distress

If you can seek an alternative please try to do so

They can be dislodged blocked etc etc

Good
Luck

As a complete amateur but one who has gone through this with my own parents, I'm surprised that they are letting her go home at all.

My dad had been managing DM at home, with two daily visits from carers who bathed her. However, after a collapse while in respite care she could no longer move.

I went with him to a meeting with social workers and local health workers and various others and it was decided that her care needs were just too high for her to go back home. She would have needed two people to turn her in bed two or three times per night, it was just not possible.

My dad was devastated and became quite depressed, in fact I think it hit him harder than when she died 4 years later. However, the home she went to was fantastic and he went to see her every afternoon, I think he only realised what an enormous physical and emotional it had all been once it was over. I would say they were both much happier those last few years.

I gather you will soon be having a meeting with the care team? You dad obviously wants to keep her at home but you must do what is the best option from a practical point of view, and if that is care in a home then you need to encourage him that that is best for him as well.

You dad obviously wants to keep her at home but you must do what is the best option from a practical point of view, and if that is care in a home then you need to encourage him that that is best for him as well.

The social worker or medical discharge team managing the meeting will look at whether DMum has capacity to decide herself what she wants and talk through her needs, what they recommend as support options and listen also to Dad and family to take it all into account - so that everyone mum wants involved can work together and understand and share any potential difficulties- so that Mum can decide.

If mum does not have capacity to decide on discharge arrangements then there is a very clear Best interests process that they follow under the mental capacity act that involves all the key people

Discharge planning meetings may more likely be virtual ones (video) or a series of telephone calls and discussions given current hospital Covid restrictions

@MrsWobble3

Thank you all so much - this is so helpful and much more informative than I have been able to get from the discharge team so far. I feel much better equipped for my next conversation - thank you.

Good 👍🏻